House Bill 453 Alabama 2026 Session

Summary

Primary Sponsor

Jennifer FidlerRepresentative

Republican

Session

2026 Regular Session

Title

Breast cancer; to require coverage of breast reconstruction surgery

Summary

HB453 would require every health insurance plan in Alabama to cover breast reconstruction after breast cancer, including public employee plans and Medicaid, with clear rules on cost-sharing, out-of-network coverage, and enforcement.

What This Bill Does

From January 1, 2027 onward, health benefit plans must pay or reimburse breast reconstruction and all related services, including revisions and nipple reconstruction, to support the reconstruction outcome. Enrollees may choose any modality, type, or technique in consultation with their health care professional, and may use out-of-network providers with in-network cost-sharing; insurers must presume medical necessity for the chosen approach and provide timely prior-authorization decisions. The bill creates an enforcement framework with civil actions, potential treble damages, and oversight by the Attorney General and the Department of Insurance, and it requires notices to enrollees detailing their rights.

Who It Affects

• Individuals enrolled in Alabama health benefit plans who have breast cancer and seek reconstruction (gain coverage and the right to choose their surgeon, modality, and technique, including out-of-network options at in-network costs).
• Health care providers, especially plastic surgeons (must be board-certified or eligible, and may treat patients regardless of network status).
• Insurers and health benefit plans (must cover breast reconstruction, manage prior authorization, reimburse out-of-network providers, and provide rights notices).
• Medicaid, the Public Education Employees' Health Insurance Plan, and the State Employees' Health Insurance Plan (coverage required starting 2027; timelines and adherence described in the bill).
• Self-funded employers (provisions may be limited or exempt for self-funded plans according to the bill’s rules).
• Regulators (Attorney General and Department of Insurance responsible for enforcement and oversight).

Key Provisions

• Adds Chapter 50A to Title 27 to require health benefit plans to cover breast reconstruction and defines the scope, modalities, types, and techniques.
• Requires coverage from January 1, 2027 for breast reconstruction and all related services necessary to achieve the reconstruction outcome, including revisions, symmetry procedures, nipple reconstruction, and related therapies.
• Permits out-of-network care with in-network cost-sharing; establishes reimbursement rules, including the lesser of billed charges or the 80th percentile for the relevant service in the area, with a process for single-case agreements when negotiating with out-of-network providers.
• Imposes a three-business-day deadline for prior-authorization decisions; requires that denials be reviewed by a board-certified or eligible plastic surgeon; outlines an internal appeal process and required disclosures (including direct contact information).
• Provides for enforcement through civil actions, including injunctive relief, compensatory and treble damages for knowing or reckless noncompliance, and attorney fees; encourages enforcement by the AG and the Commissioner of Insurance.
• Mandates notices to enrollees about rights at enrollment, renewal, and after breast cancer diagnosis or related procedures, with a model notice developed by the Commissioner.
• Includes conforming amendments to related Alabama health insurance laws and adds coverage requirements for the Public Education Employees' Plan, Medicaid, and the State Employees' Plan, with an effective date of October 1, 2026.

AI-generated summary using openai/gpt-5-nano on Feb 12, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance